Is abstinence really the best option? Exploring the role of exercise in the treatment and management of eating disorders.

Exercise prescription is suggested to help manage exercise abuse and improve overall eating disorder (ED) prognosis. This study explored emerging perceptions of ED health professionals concerning the role of exercise as a supportive treatment for EDs. Semi-structured interviews were conducted with international health professionals (n=13) with expertise in ED treatment. Verbatim transcripts were analyzed through thematic analysis. Four themes were revealed and titled 1) understanding the current state; 2) gaining perspectives; 3) barriers and benefits; 4) one size does not fit all. Within these themes, participants described the current state of exercise in ED treatment and suggested there exists a gap in research knowledge and practice. Participants also identified the implications of incorporating exercise into treatment and how an exercise protocol may be designed. Results enhance the understanding of the role of exercise in ED treatment and how it may further benefit individuals with EDs.

A qualitative examination of the perceptions of parents on the Canadian Sedentary Behaviour Guidelines for the early years.

BACKGROUND: Minimizing sedentary behavior, in particular screen-based sedentary behavior, during the early years is important for healthy growth and development. Consequently, new Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years) were recently released. Researchers are unclear what messages should supplement the guidelines when disseminating them to parents and when using the guidelines in behaviour-change interventions to increase adoption. The objective of this study was to qualitatively examine parents' perceptions of the new Canadian Sedentary Behaviour Guidelines for the Early Years. METHODS: Parents with a child ≤4 years who attended a child care centre were purposefully recruited from child care centres. A total of 7 semi-structured focus groups with 2 to 5 parents were conducted from August to November, 2013 by a trained and experienced moderator. Participants were asked a series of open-ended questions pertaining to the Sedentary Behaviour Guidelines information sheet. Initial themes were identified followed by further review and analysis. RESULTS: For the most part parents thought the guidelines were clear and did not disagree with the recommendations per se. However, some confusion arose around the value of some sedentary activities, such as reading and coloring, for social and cognitive development. Many parents described feeling guilty after reading the guidelines and perceived several barriers in meeting the daily recommendations. Common barriers included the need to balance multiple demands of family life, the prevalence and accessibility of screen technology, and the weather and built environment where families live. Parents expressed the importance of communicating the guidelines early enough for good habits to be established and the need for realistic strategies and ideas to help them meet the recommendations. CONCLUSIONS: Overall the findings indicate that gain-framed messages around the role of screen-based and non-screen-based sedentary behavior for children's cognitive and social development might be most effective for adoption of the guidelines. Furthermore, providing parents the guidelines early with resources for minimizing sedentary behavior should also be considered. Future research is needed in other demographic groups of parents to confirm these findings.

Unproven stem cell-based interventions & physicians' professional obligations; a qualitative study with medical regulatory authorities in Canada.

BACKGROUND: The pursuit of unproven stem cell-based interventions ("stem cell tourism") is an emerging issue that raises various concerns. Physicians play different roles in this market, many of which engage their legal, ethical and professional obligations. In Canada, physicians are members of a self-regulated profession and their professional regulatory bodies are responsible for regulating the practice of medicine and protecting the public interest. They also provide policy guidance to their members and discipline members for unprofessional conduct. METHODS: We conducted semi-structured telephone interviews with representatives from six different provincial Colleges of Physicians and Surgeons in Canada to discuss their experiences and perspectives regarding stem cell tourism. Our focus was on exploring how different types of physician involvement in this market would be viewed by physicians' professional regulatory bodies in Canada. RESULTS: When considering physicians' professional obligations, participants drew analogies between stem cell tourism and other areas of medical tourism as well as with some aspects of complementary alternative medicine where existing policies, codes of ethics and regulations provide some guidance. Canadian physicians are required to act in the best interests of their patients, respect patient autonomy, avoid conflicts of interest and pursue evidence-based practice in accordance with accepted standards of care. Physicians who provide unproven treatments falling outside the standard of care, not in the context of an approved research protocol, could be subject to professional discipline. Other types of problematic conduct include referrals involving financial conflict of interest and failure to provide urgent medically necessary care. Areas of ambiguity include physicians' obligations when asked for information and advice about seeking unproven medical treatments, in terms of providing non-urgent follow-up care, and when asked to support efforts to go abroad by providing tests or procedures in advance that would not otherwise be medically indicated. CONCLUSIONS: Specific policy guidance regarding the identified areas of tension or ambiguity may prove helpful for physicians struggling with these issues. Further consideration of the complex interplay of factors at issue in how physicians may (should) respond to patient demands related to unproven medical interventions while meeting their professional, legal and ethical obligations, is warranted.

The transdisciplinary health research apparatus: A Baradian account of knowledge boundaries and beyond.

This paper engages with new materialist theory to reimagine transdisciplinary health research. In particular, we draw upon Karen Barad's theory of agential realism and concept of apparatus to rethink the processes of doing transdisciplinary research. A Baradian inspired approach to transdisciplinarity encourages us to not only explore ways of knowing health phenomena differently by working across disciplines, but also to pay close attention to the politics and practices in such research. We offer a case study based on a two-year transdisciplinary research project focused on the health condition known as Low Energy Availability (LEA) in sportswomen. Through this case we highlight three key ways that Barad's concept of apparatus helped us know transdisciplinarity differently: (1) Reading disciplines through each other, (2) Intra-actions and the everyday performativity of disciplinary boundaries, and (3) Troubling the boundaries of the apparatus. Ultimately this paper illustrates the value in feminist new materialist conceptual tools for encouraging different questions of transdisciplinary research as ethico-onto-epistemological practices, processes, and politics of knowledge production.

Potential Impact of Autonomous Vehicles on Movement Behavior: A Scoping Review.

CONTEXT: This scoping review examines the literature as it relates to autonomous vehicles and impact on movement behavior (i.e., physical activity, sedentary behavior, and sleep) or mode choice (e.g., public transit), beliefs about movement behavior or mode choice, or impact on environments that may influence movement behavior or mode choice. EVIDENCE ACQUISITION: A search was conducted in June 2018 and updated in August 2019 of numerous databases (e.g., SPORTDiscuss, PubMed, and Scopus) and hand searching using terms such as autonomous cars and walking. Documents were included if they were databased studies, published in English, and related to the research question. They were then coded by 6 reviewers for characteristics of the document, design, sample, autonomous vehicles, movement behavior, and findings. The coding and analysis were conducted between August 2018 and September 2019. EVIDENCE SYNTHESIS: Of 1,262 possible studies, 192 remained after a title and abstract scan, and 70 were included after a full-article scan. Most of the studies were conducted in Europe (42%) or North America (40%), involved simulation modeling (50%) or cross-sectional (34%) designs, and were published mostly in transportation (83%) journals or reports. Of the 252 findings, 61% related to movement behavior or mode choice. Though the findings were equivocal in some cases, impacts included decreased demand for active transportation, increased demand for autonomous vehicles, increased sitting and sleeping, and reduced walking. CONCLUSIONS: Though no experimental or longitudinal studies have been published to date, the available research suggests that autonomous vehicles will impact aspects of mode choice and the built environment of people residing in much of the developed world, resulting in reduced walking and more sitting.

ParticipACTION: awareness of the participACTION campaign among Canadian adults--examining the knowledge gap hypothesis and a hierarchy-of-effects model.

BACKGROUND: ParticipACTION was a pervasive communication campaign that promoted physical activity in the Canadian population for three decades. According to McGuire's hierarchy-of-effects model (HOEM), this campaign should influence physical activity through intermediate mediators such as beliefs and intention. Also, when such media campaigns occur, knowledge gaps often develop within the population about the messages being conveyed. The purposes of this study were to (a) determine the current awareness of ParticipACTION campaigns among Canadians; (b) confirm if awareness of the ParticipACTION initiative varied as a function of levels of education and household income; and, (c) to examine whether awareness of ParticipACTION was associated with physical activity related beliefs, intentions, and leisure-time physical activity (LTPA) as suggested by the HOEM. Specifically, we tested a model including awareness of ParticipACTION (unprompted, prompted), outcome expectations, self-efficacy, intention, and physical activity status. METHODS: A population-based survey was conducted on 4,650 Canadians over a period of 6 months from August, 2007 to February, 2008 (response rate = 49%). The survey consisted of a set of additional questions on the 2007 Physical Activity Monitor (PAM). Our module on the PAM included questions related to awareness and knowledge of ParticipACTION. Weighted logistic models were constructed to test the knowledge gap hypotheses and to examine whether awareness was associated with physical activity related beliefs (i.e., outcome expectations, self-efficacy), intention, and LTPA. All analyses included those respondents who were 20 years of age and older in 2007/2008 (N = 4424). RESULTS: Approximately 8% of Canadians were still aware of ParticipACTION unprompted and 82% were aware when prompted. Both education and income were significant correlates of awareness among Canadians. The odds of people being aware of ParticipACTION were greater if they were more educated and reported higher income. Awareness of ParticipACTION was also associated with outcome expectations, self-efficacy, intention, and LTPA status. CONCLUSION: Awareness of ParticipACTION is associated with LTPA. Knowledge gaps in awareness are associated with level of education and household income. Thus, future promotion campaigns should include specific strategies to target different segments of the population, especially people who are living in deprived conditions with lower levels of education.

Taking a hard look at the Heart Truth campaign in Canada: A discourse analysis.

The Canadian Heart and Stroke Foundation launched the Heart Truth campaign to increase women's awareness of heart disease. However, little is known about how such campaigns intersect with broader understandings of gender and health. This discourse analysis examined the construction of gender, risk, and prevention within campaign material. Two primary discourses emerged: one of acceptable femininity, which outlines whose risk, survivorship, and prevention matters, and another of selfless prevention. Women of diverse ethnic, sexual, and socio-economic background were largely absent. Prevention was portrayed as a personal choice, eclipsing conversations about social determinants of health and the socio-political context of heart disease.

Assessing the feasibility, acceptability and potential effectiveness of an integrated approach to smoking cessation for new and expectant fathers: The Dads in Gear study protocol.

BACKGROUND: Evidence related to the effects of tobacco exposure in pregnancy and on infant and child health have focused on women's smoking cessation. Less often addressed is men's smoking, which when continued in fatherhood, reduces the chances of female partners' cessation and can negatively impact children's health as well as men's health. Dads in Gear (DIG) is an innovative program designed specifically for new fathers who want to reduce and quit smoking that includes three components: smoking cessation, fathering, and physical activity. The over-arching purpose of this study is to evaluate the feasibility of the DIG program and provide estimates of program efficacy. The purpose of this article is to describe the rationale and protocol for evaluating the DIG program's feasibility, acceptability and potential effectiveness. METHODS: Using a prospective, non-comparative design, the DIG program will be implemented and evaluated in six communities. The program will be offered by trained facilitators to fathers who currently smoke and want to quit. The RE-AIM framework will guide the evaluation. Open-ended questions in participant surveys, and semi-structured interviews and weekly telephone de-briefs with facilitators will provide data for a process evaluation. Estimates of effectiveness include smoking behavior, fathering and physical activity measures at baseline, end of program, and 3-month follow up. CONCLUSION: The DIG program could support positive changes with respect to smoking cessation, physical activity and overall health for men. These effects could also promote family health. The program might also provide an effective model for engaging men in other health behavior change.

Innovative approach for increasing physical activity among breast cancer survivors: protocol for Project MOVE, a quasi-experimental study.

INTRODUCTION: Physical activity is a cost-effective and non-pharmaceutical strategy that can help mitigate the physical and psychological health challenges associated with breast cancer survivorship. However, up to 70% of women breast cancer survivors are not meeting minimum recommended physical activity guidelines. Project MOVE is an innovative approach to increase physical activity among breast cancer survivors through the use of Action Grants, a combination of microgrants (small amounts of money awarded to groups of individuals to support a physical activity initiative) and financial incentives. The purpose of this paper is to describe the rationale and protocol of Project MOVE. METHOD AND ANALYSIS: A quasi-experimental pre-post design will be used. Twelve groups of 8-12 adult women who are breast cancer survivors (N=132) were recruited for the study via face-to-face meetings with breast cancer-related stakeholders, local print and radio media, social media, and pamphlets and posters at community organisations and medical clinics. Each group submitted a microgrant application outlining their proposed physical activity initiative. Successful applicants were determined by a grant review panel and informed of a financial incentive on meeting their physical activity goals. An evaluation of feasibility will be guided by the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework and assessed through focus groups, interviews and project-related reports. Physical activity will be assessed through accelerometry and by self-report. Quality of life, motivation to exercise and social connection will also be assessed through self-report. Assessments will occur at baseline, 6 months and 1 year. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of British Columbia's Behavioural Research Ethics Board (#H14-02502) and has been funded by the Canadian Cancer Society Research Institute (project number #702913). Study findings will be disseminated widely through peer-reviewed publications, academic conferences, local community-based presentations, as well as partner organisations, including the Canadian Cancer Society.

Representations of the health value of vitamin D supplementation in newspapers: media content analysis.

OBJECTIVE: To examine the nature of media coverage of vitamin D in relation to its role in health and the need for supplements. DESIGN: Media content analysis. SETTING: Print articles from elite newspapers in the UK, the USA and Canada. PARTICIPANTS: 294 print newspaper articles appearing over 5 years (2009-2014). RESULTS: Newspaper coverage of vitamin D generally supported supplementation. The most common framing of vitamin D in print articles was "adequate vitamin D is necessary for good health." Articles also framed vitamin D as difficult to obtain from food supply and framed vitamin D deficiency as a widespread concern. In discussions of supplementation, 80% articles suggested supplementation is or may be necessary for the general population, yet almost none of the articles discussed the potential harms of vitamin D supplementation in any detail. Print articles named 40 different health conditions in relationship to vitamin D. The most commonly cited conditions included bone health, cancer and cardiovascular health. Although print articles referred to a wide range of scholarly research on vitamin D with varying degrees of endorsement for supplementation, a general tone of support for vitamin D supplementation in media coverage persisted. CONCLUSIONS: Newspaper articles conveyed overall support for vitamin D supplementation. News articles linked vitamin D to a wide range of health conditions for which there is no conclusive scientific evidence. Media coverage downplayed the limitations of existing science and overlooked any potential risks associated with supplementation.

Effectiveness of voice therapy in functional dysphonia: where are we now?

PURPOSE OF REVIEW: To review the recent literature since the 2009 Cochrane review regarding the effectiveness of voice therapy for patients with functional dysphonia. RECENT FINDINGS: A range of articles report on the effects of voice therapy treatment for functional dysphonia, with a wide range of interventions described. Only one study is a randomized controlled trial. A number of excellent review articles have extended the knowledge base. In primary research, methodological issues persist: studies are small, and not adequately controlled. Studies show improved standards of outcome measurement and of description of the content of voice therapy. SUMMARY: There is a continued need for larger, methodologically sound clinical effectiveness studies. Future studies need to be replicable and generalizable in order to inform and elucidate clinical practice.

Key stakeholder perspectives on the development of walkable neighbourhoods.

Evidence supports the link between the built environment and physical activity. This study investigated factors that influence the decisions made by key stakeholders as they relate to neighbourhood development. Seventeen stakeholders including public health and municipal employees (n=9), city councillors (n=3), and the private sector (e.g., land developers, food retailers) (n=5), participated in interviews. Private sector participants considered healthy lifestyle choices (e.g., PA) to be related more to individual choice than did other groups. All groups agreed that consumer behaviour is essential to invoking change but did not agree on who is responsible for invoking change. Common barriers included financial costs, car dependency, and social norms. Facilitators included growing awareness of health and environmental issues and increasing buy-in from governing bodies for innovative neighbourhood development. More work is needed that acknowledges the differences between while integrating the diverse perspectives of those responsible for the planning of neighbourhoods that are conducive for physical activity.

The role of self-efficacy in explaining gender differences in physical activity among adolescents: a multilevel analysis.

BACKGROUND: The purposes of this study were to determine if a) gender moderated the relationship between self-efficacy and physical activity (PA) among youth in Alberta, Canada, and, alternatively b) if self-efficacy mediated the relationship between gender and PA. METHODS: A novel web-based tool was used to survey a regionally diverse sample of 4779 students (boys = 2222, girls = 2557) from 117 schools in grades 7 to 10 (mean age = 13.64 yrs.). Among other variables, students were asked about their PA and self-efficacy for participating in PA. RESULTS: Based upon a series of multilevel analyses, self-efficacy was found to be a significantly stronger correlate of PA for girls. But, boys had significantly higher self-efficacy compared with girls, which resulted in significantly more PA. CONCLUSIONS: Findings suggest self-efficacy is an important correlate of PA among adolescent girls but that boys are more physically active because they have more self-efficacy for PA.

A mixed methods evaluation of televised health promotion advertisements targeted at older adults.

The purpose of this research was to evaluate television advertisements targeted at 55-70-year olds that promoted physical activity and fruit and vegetable consumption. Awareness of the campaign, perceived credibility of the source, intentions to visit a promoted website, and intentions to perform the healthy behaviors were evaluated using mixed methods research. Results from a population level survey (n=1600) showed low unprompted and prompted awareness of the campaign and no differences in intentions or behaviors among those who were aware of the campaign. Unprompted recall resulted in a very wide range of responses including the citation of many commercial advertisers. Qualitative themes that emerged from the focus groups included neutral, positive, and negative comments about the advertisements, source credibility, website considerations specific to seniors, and suggestions about appropriate advertising for older adults. This research showed that the increased attention paid to the advertisements was due in a large part to negative reactions to the character used in the advertisements. Another important finding was the government was not considered to be a credible source of health information. Finally, health promoters should be cautious about websites as the primary source of information, particularly for older adults.